Sirago - Ultimate Gap Cover

Sirago - Ultimate Gap Cover

Sirago Ultimate Gap Cover is comprehensive gap cover, for peace of mind.

It includes generous in-hospital gap cover and co-payment cover; cover for emergency room treatment, outpatient consultations and surgical procedures, care at step-down facilities, and preventative care and trauma counselling; and extended cancer benefits.

Gap Cover Benefits

Co-payment benefit

Benefit covers all procedural co-payments as well as admission on penalty fees imposed by the medical scheme rules, subject to OAL. Percentage co-payment limit of R16,000 per claim. Penalty per cover has an incident limit per claim of R10,500 limited to 3 claims pppa

Dental benefit

In-hospital dental: gap and co-payments, subj to OAL. This benefit is not limited to impacted wisdom teeth

Diagnosis benefit

Once-off payment of R22,500 for first time cancer diagnosis

Emergency/casualty benefit

Overall sub-limit of R12,000 per policy per year. R5,000 for accidents and trauma related incidents, limited to R750 per claim

Full time students over 21

Covered up to the age of 27 as long as they are full-time students (including if they are on their own option) – they do not have to be unmarried

Gap cover limits

An Overall Annual Limit (OAL) of R164,000 per beneficiary, for in- and out-of-Hospital surgical procedures

Gap cover percentage benefit

Gap Cover will settle claims at an additional 500% above your Medical Scheme rate or at the stated benefit value, for hospital admissions; doctors, specialists, basic radiology, pathology, physiotherapy. Procedures performed as an outpatient basis are also covered (see list of procedures in policy document)

Lives Covered

Main medical scheme member; All family members registered as medical scheme dependants OR no more than 2 Adults and 3 Child dependants on different medical schemes

Maximum entry age

There is no maximum entry age applicable

Oncology benefit

A R100,000 per policy applies once your medical scheme oncology benefit limit has been reached and a percentage co-payment is applied. Breast reconstruction is paid up to 300% of the gap portion and R25,000 (Stated benefit) for the reconstruction of the non-affected breast

Oncology supplementary benefit

A R100,000 per beneficiary and subj to OAL is applied when medical scheme oncology benefit is reached and you require further treatment. Breast reconstruction is paid up to 300% of the gap portion and R25,000 (Stated benefit) for the reconstruction of the non-affected breast

PMB cover

Prescribed Minimum Benefits are covered

Voluntary use of non-DSP for PMB treatment is covered.

*No cover for emergency or involuntary PMB treatment

Sub-limit benefit

Enhancer benefit limit of R100,000 pfpa; with a sub-limit of R25,000 per incident, subject to 4 claims per policy and OAL

Trauma counselling

Limit of R5,000 pppa. Limited to a stated benefit of R750 per claim. Covers, but not limited to; Dread Disease, Hijacking and or Violent Crimes

Gap Cover Contributions

Contributions

Single 0 - 54yrs

R 413


Single 55 - 64yrs

R 491


Single 65yrs+

R 569


Family 0 - 54yrs

R 467


Family 55 - 64yrs

R 556


Family 65yrs+

R 645

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